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lymphoma incidence in New Zealand: Acute leukaemia subtypes in the South Island of New Zealand, 1983–1984
0145-212h/ti5SJ.W Pergamon
+- 0.00 I’rc\*
I rd
LEUKAEMIA/LYMPHOMA INCIDENCE IN NEW ZEALAND: ACUTE LEUKAEMIA SUBTYPES IN THE SOUTH ISLAND OF NEW ZEALAND, 1983-1984 M. E. J. BEARD, D. N. J. HART, P. HAWKINS, M. SOUTHERIU‘ and P. H. FITZGERALD Department of Haematology and Cytogenetics, Christchurch Hospital, Christchurch, New Zealand TABLE I. THE NEW ZEALAND POPULATION
NEW ZEALAND lies between latitudes 34” S and 48” S in the South Pacific ocean. It is in the path of the midlatitude westerlies and has a temperature, maritime climate. Annual mean temperatures range from 15 to 7.S”C, annual rainfall from X000 to 300 mm, and annual sunshine from 2500 to 1600 hr. New Zealand consists mainly of two islands, the North Island with a population of about 2,322,989 and the South Island with a population of about 852, 748 (1981 census). INCIDENCE
Maori
1964
2,410,210
187,970
1970
2,808,590
225,435
1979
3,124,4OO
285,600
OF LEUKAEMIA/LYMPHOMA IN NEW
ZEALAND subtypes over the past few years at least as judged by the occurrence of patients with a mediastinal mass or with leukaemic cells having a Burkitt-like morphology.
The following information has been obtained from the Cancer Data Section of the New Zealand Annual Health Statistics Report published by the New Zealand Department of Health. Currently the latest published data relates to 1979. Preliminary analysis of unpublished data for the years 1980 to 1982 does not reveal any new trends in the frequency of leukaemia or lymphoma. However, the ICD categories are not readily translated into any of the non-Hodgkin’s lymphoma classifications in current use and significant changes could have occurred in specific subtypes within this group of disorders. Table 1 shows the New Zealand population and Table 2, the standardised cancer incidence rates for the Maori and non-Maori populations. Some marked differences in cancer rates are seen. Hepatitis B antigen and antibody are present in higher frequency in the Maori and this probably accounts for the higher incidence of liver cancer. Table 3 looks at standardised incidence rates within ICD codes 200-208 from 1947 to 1979 and shows the higher incidence of myeloma in the Maori population. Table 4 looks at cancer deaths in New Zealand from 1951 to 1979 and a progressive rise in both “reticuloses” (ICD codes 200-203) and leukaemia (ICD codes 204-207) is seen. Table 5 looks at the number of acute leukaemia registrations from 1976 to 1979. Apart from a higher frequency in males, no other differences or trends are seen. At an anecdotal level, although both T and B ALL occur in New Zealand, no overt increase has been noted in these Abbreviations:
Total
IC’D,
IIiseases. Key words: Ethnic munophenotype.
International groups,
Classification
leukaemia
incidence,
ACUTE LEUKAEMIA SUBTYPES, SOUTH ISLAND, NEW ZEALAND 1983-1984 An attempt was made to analyse all cases of acute leukaemia occurring in a defined area over a 12-month period. Forty-one cases of acute leukaemia occurred in this population of 852,748 or 1 per 20,709 per yr or 4.7 per 100,000 per yr. Detailed analyses were carried out on 31 of these cases. The numbers for each of the major types of acute leukaemia are shown in Table 6. The numbers are too small to draw any definite conclusions but it is slightly surprising that four patients with Ph’positive ALL ivere seen and that all four patients with the blast crisis of CML were lymphoid. Tables 7-10 give detailed haematological, cytogenetic and surface marker correlations. Comment In view of the ICD coding system and the small number of acute leukaemia patients analysed, no definite conclusions can be drawn. However, this study does emphasise the crucial importam?e of cytogenetic analyses in any investigation of the subtypes of acute leukaemia. In the New Zealand context it would appear valuable:
ot
(1) To continue 2-3 yr. (2) To compare
in-
803
the South Island studies for a further the incidence
of the various subtypes
M. E. J. BEAKD er al.
804
of acute leukaemia in Maori and Non-Maori populations. TABLE
2.
*(3) To initiate similar analyses in the non-Hodgkin’s lymphomas.
MAORI AND NON-MAORI STANDARDISEDCANCERINCIDENCERATES 1977-79*
Standardised
Total numbers 1977-1979
rates
per 100,000 population Maori
Non-Maori
Maori
Non-Maori
Stomach
21.1
9.4
78
1079
Large intestine
11.o
28.0
49
2970
7.0
13.5
24
1433
7.9
I.7
30
172
6.6
39
716
32.1
271
3425
Rectum & rectosigmoid
junction
Liver Pancreas
Il.7
Lung
17.7
Melanoma
of skin
Breast Cervix
Uteri
1.3
17.0
57.6
60.2
128
8
3044
IS46
23.8
12.9
62
598
290.4
243.1
All sites
(I 40-207)
*No significant differences brain and thyroid.
for oesophagus,
ovary,
1177
prostate,
25,088
testis, bladder,
kidney,
TABLE 3. MAORIAND NON-MAORISTAKDARDI~EDINCIDENCERATES
Standardised rates per 100,OCG population
Site
Maori
Total numbers
Non-hlaori
.Maorl
Non-Maori
1974-1976 Lymphosarcoma cell sarcoma Multiple
myeloma
Lymphatic Myeloid
and reticulum
leukaemia
leukaemia
All sites (140-207)
3.1
2.8
14
279
5.4
2.5
13
267
2.3
2.7
II
270
6.8
3.5
30
346
304.0
237.3
1070
23,477
3.2
3.4
17
344
5.6
2.7
21
295
1.6
2.8
I2
273
3.9
3.3
21
329
290.4
243.1
1177
25,088
1977-1979 Lymphosarcoma cell sarcoma Multiple
myeloma
Lymphatic Myeloid
and reticulum
leukaemia
leukaemia
All sites (140-207) ___--
___.
ALL in New Zealand
805
TABLE 4. CANCER DATA IN NEW ZEALAND. WORLD STANDARDISED RATES PER 100,000 POPULATION
1966-70
1961-55
1951-5s
1976-80
M
F
M
F
M
F
M
F
M
F
200-203
reticuloses
5
3
8
4
1
5
9
5
8
6
204-207
leukaemia
5
4
6
5
5
3
7
5
7
4
TABLE
TABLE 5. LEUKAEMIC REGISTRATIONS
Leukaemia
1971-7s
MEAN
Sex
Detailed
6.
TYPES OF ACUTE 1983-1984
site numbers
Total
1976
1977
1978
1979
LEUKAEMIA
Detailed
testing
AML
M
13
25
27
17
204.0
F
17
14
9
17
ALL (Ph’)
4
4
AUL
2
2
ALL
M
57
43
52
43
205.0
F
34
35
40
41
Other AL
M
5
3
8
6
207.0
F
6
5
2
3
CMLBC -
myeloid
0
0
-
lymphoid
3
3
41
31
208.0 Totals
TABLE 7. DETAILED ANALYSES OF 31 PATIENTSWITH ACUTE LEUKAEMIA 1983-84 - ACUTE MYELOID LEUKAES~IA Cytogenetics
AML FAB type
JR
M4
Normal
NM
M2
45,5q-12q-22q
CR
M6
Probably
RN
MI
RG
Surface
+
normal
marker analysis
CH-CH*
LRF Centret
AMML
AML
AML
AML
EL
EL
Normal
AML
AML
Ml
Normal
AML
AML
WK
M3
t (15;17)
APML
AML
RD
M2
Multiple
AML
AML
JO’C
M2
47, + 8
AML
AML
BS
Ml
48, +C+C
AML
AML
AK
M2
t (8;21)
AML
AML
SC
M5
Normal
AMoL
AML
t (11;18)
RP
M2
t (5;16)
AML
AML
ML
Ml
Normal
AML
AML
AB
?Ml
Normal
AML
AML
*Christchurch tLeukaemia
Hospital, Christchurch Research Fund Centre.
this issue for details.
(New Zealand). See paper by Greaves
et al. in
M. E. J.
806
BEARDef
at.
TABLE 8. DETAILED ANALYSES OF 31 PATIENTS WITH ACUTE LEUKAEMIA ACUTE LEUKAEMIA ? LYMPHOID Surface
ALL FAB
marker analyses Centre
type
Cytogenetics
GF ALL L2
48147
c-ALL
c-ALL
HF ALLLI
Normal
c-ALL
c-ALL
AN ALL Ll
so/51
c-ALL
c-ALL
LB ALLLl
Multiple abnormal
c-ALL
c-ALL
MK ALL Ll
Normal
T ALL
T ALL
AG ALL Ll
56 multiple
c-ALL
c-ALL
OM ALL L2
Normal
c-ALL
c-ALL
KR ALL Ll
Normal
AL ? type
ALL unclass.
CH-CH
LRF
TABLE 9. DETAILED ANALYSES OF 31 PATIENTS WITH ACUTE LEUKAEMIA 1983-84 - ACUTE LEUKAEMIA(UNDIFFERESTIATED)
Acute leukaemia type
AP
Cytogenetics
CH-CH
LRF Centre
Multiple
AL ? type
Uncertain
AML(?) t (9;14)
AL ? type
Uncertain
AL (?)
IB
Surface marker analysis
TABLE 10. DETAILED ANALYSES OF 31 PATIENTSWITH ACUTE LEUUEMIA 1983-84
Type of acute leukaemia
-
Ph’ POSITIVELEUKAEMIA
Surface marker analyses
Cytogenetics
LRF Centre
CH-CH
t (9;22) t (9;22) t (9;22)
CMLBC lymphoid
CALL +
CMLBC lymphoid
CALL +
CMLBC lymphoid
CMLBC lymphoid
CALL-
CMLBC lymphoid
Ll
Multiple all t (9;22)
Ph’ + ALL
CALL +
CMLBC lymphoid
L2
48 all t (9;22)
Ph’ + AL
CALL-
CMLBC
NH
CMLBC
Ll
NF
CMLBC
Ll
SB
CMLBC
Ll
TO
ALL
MT
ALL
KS
ALL
L2
Multiple all t (9;22)
JB
ALL
L2
1 metaphase
double
t (9;22)
CMLBC lymphoid
Ph’ + AL
CALL-
ALL unclass subtype
Ph’ + AL
CALL-
ALL unclass subtype
ALL in New Zealand
ADDENDUM
Island (Prof. J. D. Wilson). This centre is expected to see more Maori and Polynesian patients than Christchurch in the South Island. The ALL subgroup data from Auckland is provided in Table 1A. The numbers to date are small but it is of interest to note that both common ALL and T-ALL are recorded in Maori and Polynesian patients.
Editors’ note: ALL subtypes of patients from North Island, New Zealand (Auckland). Seventeen patients with ALL have also been entered into the study by the New Zealand group based in Auckland, North
TABLE
1A. ALL
807
SUBSETS:
AUCKLAND,
Patient
Age/sex
Subset
NEW
ZEALAND
Ethnic group
I
21 a
T
W
2
19 cr
T
Indian
3
21 w
T
Maori
4
15 a
T
W
5
18 u
T
Polynesian (W. Samoa)
6
15 w
T
W
7
6Oa
CALL
Maori
8
17 0
CALL
W
9
18 w
CALL
W
10
2a
CALL
W
11 12
89 5w
CALL
W
CALL
W
11 9
CALL
W
13 14
39
CALL
W
15
15 Q
CALL
Polynesian
I6
52 Q
null-ALL W
17
78 0
null-ALL W
W = White.
+- 0.00 I’rc\*
I rd
LEUKAEMIA/LYMPHOMA INCIDENCE IN NEW ZEALAND: ACUTE LEUKAEMIA SUBTYPES IN THE SOUTH ISLAND OF NEW ZEALAND, 1983-1984 M. E. J. BEARD, D. N. J. HART, P. HAWKINS, M. SOUTHERIU‘ and P. H. FITZGERALD Department of Haematology and Cytogenetics, Christchurch Hospital, Christchurch, New Zealand TABLE I. THE NEW ZEALAND POPULATION
NEW ZEALAND lies between latitudes 34” S and 48” S in the South Pacific ocean. It is in the path of the midlatitude westerlies and has a temperature, maritime climate. Annual mean temperatures range from 15 to 7.S”C, annual rainfall from X000 to 300 mm, and annual sunshine from 2500 to 1600 hr. New Zealand consists mainly of two islands, the North Island with a population of about 2,322,989 and the South Island with a population of about 852, 748 (1981 census). INCIDENCE
Maori
1964
2,410,210
187,970
1970
2,808,590
225,435
1979
3,124,4OO
285,600
OF LEUKAEMIA/LYMPHOMA IN NEW
ZEALAND subtypes over the past few years at least as judged by the occurrence of patients with a mediastinal mass or with leukaemic cells having a Burkitt-like morphology.
The following information has been obtained from the Cancer Data Section of the New Zealand Annual Health Statistics Report published by the New Zealand Department of Health. Currently the latest published data relates to 1979. Preliminary analysis of unpublished data for the years 1980 to 1982 does not reveal any new trends in the frequency of leukaemia or lymphoma. However, the ICD categories are not readily translated into any of the non-Hodgkin’s lymphoma classifications in current use and significant changes could have occurred in specific subtypes within this group of disorders. Table 1 shows the New Zealand population and Table 2, the standardised cancer incidence rates for the Maori and non-Maori populations. Some marked differences in cancer rates are seen. Hepatitis B antigen and antibody are present in higher frequency in the Maori and this probably accounts for the higher incidence of liver cancer. Table 3 looks at standardised incidence rates within ICD codes 200-208 from 1947 to 1979 and shows the higher incidence of myeloma in the Maori population. Table 4 looks at cancer deaths in New Zealand from 1951 to 1979 and a progressive rise in both “reticuloses” (ICD codes 200-203) and leukaemia (ICD codes 204-207) is seen. Table 5 looks at the number of acute leukaemia registrations from 1976 to 1979. Apart from a higher frequency in males, no other differences or trends are seen. At an anecdotal level, although both T and B ALL occur in New Zealand, no overt increase has been noted in these Abbreviations:
Total
IC’D,
IIiseases. Key words: Ethnic munophenotype.
International groups,
Classification
leukaemia
incidence,
ACUTE LEUKAEMIA SUBTYPES, SOUTH ISLAND, NEW ZEALAND 1983-1984 An attempt was made to analyse all cases of acute leukaemia occurring in a defined area over a 12-month period. Forty-one cases of acute leukaemia occurred in this population of 852,748 or 1 per 20,709 per yr or 4.7 per 100,000 per yr. Detailed analyses were carried out on 31 of these cases. The numbers for each of the major types of acute leukaemia are shown in Table 6. The numbers are too small to draw any definite conclusions but it is slightly surprising that four patients with Ph’positive ALL ivere seen and that all four patients with the blast crisis of CML were lymphoid. Tables 7-10 give detailed haematological, cytogenetic and surface marker correlations. Comment In view of the ICD coding system and the small number of acute leukaemia patients analysed, no definite conclusions can be drawn. However, this study does emphasise the crucial importam?e of cytogenetic analyses in any investigation of the subtypes of acute leukaemia. In the New Zealand context it would appear valuable:
ot
(1) To continue 2-3 yr. (2) To compare
in-
803
the South Island studies for a further the incidence
of the various subtypes
M. E. J. BEAKD er al.
804
of acute leukaemia in Maori and Non-Maori populations. TABLE
2.
*(3) To initiate similar analyses in the non-Hodgkin’s lymphomas.
MAORI AND NON-MAORI STANDARDISEDCANCERINCIDENCERATES 1977-79*
Standardised
Total numbers 1977-1979
rates
per 100,000 population Maori
Non-Maori
Maori
Non-Maori
Stomach
21.1
9.4
78
1079
Large intestine
11.o
28.0
49
2970
7.0
13.5
24
1433
7.9
I.7
30
172
6.6
39
716
32.1
271
3425
Rectum & rectosigmoid
junction
Liver Pancreas
Il.7
Lung
17.7
Melanoma
of skin
Breast Cervix
Uteri
1.3
17.0
57.6
60.2
128
8
3044
IS46
23.8
12.9
62
598
290.4
243.1
All sites
(I 40-207)
*No significant differences brain and thyroid.
for oesophagus,
ovary,
1177
prostate,
25,088
testis, bladder,
kidney,
TABLE 3. MAORIAND NON-MAORISTAKDARDI~EDINCIDENCERATES
Standardised rates per 100,OCG population
Site
Maori
Total numbers
Non-hlaori
.Maorl
Non-Maori
1974-1976 Lymphosarcoma cell sarcoma Multiple
myeloma
Lymphatic Myeloid
and reticulum
leukaemia
leukaemia
All sites (140-207)
3.1
2.8
14
279
5.4
2.5
13
267
2.3
2.7
II
270
6.8
3.5
30
346
304.0
237.3
1070
23,477
3.2
3.4
17
344
5.6
2.7
21
295
1.6
2.8
I2
273
3.9
3.3
21
329
290.4
243.1
1177
25,088
1977-1979 Lymphosarcoma cell sarcoma Multiple
myeloma
Lymphatic Myeloid
and reticulum
leukaemia
leukaemia
All sites (140-207) ___--
___.
ALL in New Zealand
805
TABLE 4. CANCER DATA IN NEW ZEALAND. WORLD STANDARDISED RATES PER 100,000 POPULATION
1966-70
1961-55
1951-5s
1976-80
M
F
M
F
M
F
M
F
M
F
200-203
reticuloses
5
3
8
4
1
5
9
5
8
6
204-207
leukaemia
5
4
6
5
5
3
7
5
7
4
TABLE
TABLE 5. LEUKAEMIC REGISTRATIONS
Leukaemia
1971-7s
MEAN
Sex
Detailed
6.
TYPES OF ACUTE 1983-1984
site numbers
Total
1976
1977
1978
1979
LEUKAEMIA
Detailed
testing
AML
M
13
25
27
17
204.0
F
17
14
9
17
ALL (Ph’)
4
4
AUL
2
2
ALL
M
57
43
52
43
205.0
F
34
35
40
41
Other AL
M
5
3
8
6
207.0
F
6
5
2
3
CMLBC -
myeloid
0
0
-
lymphoid
3
3
41
31
208.0 Totals
TABLE 7. DETAILED ANALYSES OF 31 PATIENTSWITH ACUTE LEUKAEMIA 1983-84 - ACUTE MYELOID LEUKAES~IA Cytogenetics
AML FAB type
JR
M4
Normal
NM
M2
45,5q-12q-22q
CR
M6
Probably
RN
MI
RG
Surface
+
normal
marker analysis
CH-CH*
LRF Centret
AMML
AML
AML
AML
EL
EL
Normal
AML
AML
Ml
Normal
AML
AML
WK
M3
t (15;17)
APML
AML
RD
M2
Multiple
AML
AML
JO’C
M2
47, + 8
AML
AML
BS
Ml
48, +C+C
AML
AML
AK
M2
t (8;21)
AML
AML
SC
M5
Normal
AMoL
AML
t (11;18)
RP
M2
t (5;16)
AML
AML
ML
Ml
Normal
AML
AML
AB
?Ml
Normal
AML
AML
*Christchurch tLeukaemia
Hospital, Christchurch Research Fund Centre.
this issue for details.
(New Zealand). See paper by Greaves
et al. in
M. E. J.
806
BEARDef
at.
TABLE 8. DETAILED ANALYSES OF 31 PATIENTS WITH ACUTE LEUKAEMIA ACUTE LEUKAEMIA ? LYMPHOID Surface
ALL FAB
marker analyses Centre
type
Cytogenetics
GF ALL L2
48147
c-ALL
c-ALL
HF ALLLI
Normal
c-ALL
c-ALL
AN ALL Ll
so/51
c-ALL
c-ALL
LB ALLLl
Multiple abnormal
c-ALL
c-ALL
MK ALL Ll
Normal
T ALL
T ALL
AG ALL Ll
56 multiple
c-ALL
c-ALL
OM ALL L2
Normal
c-ALL
c-ALL
KR ALL Ll
Normal
AL ? type
ALL unclass.
CH-CH
LRF
TABLE 9. DETAILED ANALYSES OF 31 PATIENTS WITH ACUTE LEUKAEMIA 1983-84 - ACUTE LEUKAEMIA(UNDIFFERESTIATED)
Acute leukaemia type
AP
Cytogenetics
CH-CH
LRF Centre
Multiple
AL ? type
Uncertain
AML(?) t (9;14)
AL ? type
Uncertain
AL (?)
IB
Surface marker analysis
TABLE 10. DETAILED ANALYSES OF 31 PATIENTSWITH ACUTE LEUUEMIA 1983-84
Type of acute leukaemia
-
Ph’ POSITIVELEUKAEMIA
Surface marker analyses
Cytogenetics
LRF Centre
CH-CH
t (9;22) t (9;22) t (9;22)
CMLBC lymphoid
CALL +
CMLBC lymphoid
CALL +
CMLBC lymphoid
CMLBC lymphoid
CALL-
CMLBC lymphoid
Ll
Multiple all t (9;22)
Ph’ + ALL
CALL +
CMLBC lymphoid
L2
48 all t (9;22)
Ph’ + AL
CALL-
CMLBC
NH
CMLBC
Ll
NF
CMLBC
Ll
SB
CMLBC
Ll
TO
ALL
MT
ALL
KS
ALL
L2
Multiple all t (9;22)
JB
ALL
L2
1 metaphase
double
t (9;22)
CMLBC lymphoid
Ph’ + AL
CALL-
ALL unclass subtype
Ph’ + AL
CALL-
ALL unclass subtype
ALL in New Zealand
ADDENDUM
Island (Prof. J. D. Wilson). This centre is expected to see more Maori and Polynesian patients than Christchurch in the South Island. The ALL subgroup data from Auckland is provided in Table 1A. The numbers to date are small but it is of interest to note that both common ALL and T-ALL are recorded in Maori and Polynesian patients.
Editors’ note: ALL subtypes of patients from North Island, New Zealand (Auckland). Seventeen patients with ALL have also been entered into the study by the New Zealand group based in Auckland, North
TABLE
1A. ALL
807
SUBSETS:
AUCKLAND,
Patient
Age/sex
Subset
NEW
ZEALAND
Ethnic group
I
21 a
T
W
2
19 cr
T
Indian
3
21 w
T
Maori
4
15 a
T
W
5
18 u
T
Polynesian (W. Samoa)
6
15 w
T
W
7
6Oa
CALL
Maori
8
17 0
CALL
W
9
18 w
CALL
W
10
2a
CALL
W
11 12
89 5w
CALL
W
CALL
W
11 9
CALL
W
13 14
39
CALL
W
15
15 Q
CALL
Polynesian
I6
52 Q
null-ALL W
17
78 0
null-ALL W
W = White.